甲状腺乳头状癌伴桥本甲状腺炎的超声表现及其与侵袭性和BRAF^V600E突变的关系  

Relationship between ultrasonographic features of papillary thyroid carcinoma with Hashimoto’s thyroiditis and its invasiveness and BRAFV600E mutations

作　　者：陈妮[1] 黄晓玲[1] 刘丽萍[1] 李茂萍[1] 彭晓琼[1] CHEN Ni;HUANG Xiaoling;LIU Liping;LI Maoping;PENG Xiaoqiong(Department of Ultrasound,the First Affiliated Hospital,Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院超声科,重庆市400016

出　　处：《临床超声医学杂志》2020年第7期515-518,共4页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨桥本甲状腺炎(HT)是否会影响甲状腺乳头状癌(PTC)的常规超声特征表现,及其与侵袭性和BRAFV600E突变的关系。方法将158例经手术证实的PTC患者分为HT组和非HT组,每组各79例,比较两组常规超声、超声造影及弹性成像特征,以及侵袭性和BRAFV600E突变的差异性。应用二元Logistic回归分析超声特征与BRAFV600E基因突变的相关性。结果 HT组中女性患者比例高于非HT组,差异有统计学意义(P<0.05)。两组超声特征(病灶边界、纵横比、微小癌、微钙化、病灶数目、颈部淋巴结转移)、超声造影增强模式、弹性成像评分比较差异均无统计学意义。158例患者中,18例侵袭周围组织,其中HT组5例,非HT组13例;135例BRAFV600E突变阳性,其中HT组63例,非HT组72例,差异均有统计学意义(均P<0.05)。135例BRAFV600E突变阳性病例中,两组淋巴结转移比较差异无统计学意义;侵袭周围组织情况比较差异有统计学意义(P<0.05)。二元Logistic回归分析显示,158例PTC患者中,微小癌和纵横比>1与BRAFV600E突变阳性相关(OR=3.087、3.798,均P<0.05);HT组患者中,微小癌与BRAFV600E突变阳性相关(OR=3.590,P<0.05)。结论 PTC合并HT好发于女性,HT不影响PTC的超声特征表现,合并HT的PTC其侵袭性及BRAFV600E基因突变率均低于单纯的PTC;在PTC中,BRAFV600E基因突变与微小病灶、纵横比>1均相关;合并HT的PTC中BRAFV600E基因突变与微小病灶相关。Objective To investigate whether Hashimoto’s thyroiditis affects the sonographic features of papillary thyroid carcinoma(PTC) and its relationship with its invasiveness and BRAFV600E mutations.Methods A total of 158patients with positive PTC were divided into HT group and non-HT group(79 cases in each group).The features of conventional ultrasound and contrast-enhanced ultrasound,elastography,invasiveness and BRAFV600E mutations were compared between the two groups.Binary Logistic regression was used to analyze the correlation between ultrasound features and BRAFV600E mutations.Results The proportion of female patients in HT group was higher than that in non-HT group(P<0.05).There were no significant differences between the two groups in ultrasonic features(boundary of lesion,aspect ratio,microcarcinoma,microcalcification,number of lesion,cervical lymph node metastasis),contrast-enhanced ultrasound mode and elastography scores.Among 158 cases,18 cases invaded the surrounding tissues,5 cases in HT group and 13 cases in non-HT group.135 cases were BRAFV600E mutations positive,63 cases in HT group and 72 cases in non-HT group,the differences were statistically significant(all P<0.05).In 135 BRAFV600E mutations positive cases,there was no significant difference in lymph node metastasis between the two groups,but there was significant difference in invasion(P<0.05).In 158patients with PTC,BRAFV60 E mutations was positively correlated with microcarcinoma and aspect ratio>1(OR=3.087,3.798,both P<0.05),and BRAFV600E mutations was positively correlated with microcarcinoma in HT group(OR=3.590,P<0.05).Conclusions PTC with HT is more common in women.The presence of HT can not affect the sonographic features of PTC,the invasiveness of PTC with HT and the mutation rate of BRAFV600E gene are lower than that of PTC.In PTC,the mutations of BRAFV600E is related to microfocus,aspect ratio>1.Mutations of BRAFV600E gene in PTC with HT are associated with microlesions.

关 键 词：超声成像 甲状腺乳头状癌 桥本甲状腺炎 BRAFV600E 

分 类 号：R445.1[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学]